Healthcare Provider Details

I. General information

NPI: 1811418395
Provider Name (Legal Business Name): KRYSTAL LYNN TAULAI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2017
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4585 SW 185TH AVE
ALOHA OR
97078-1557
US

IV. Provider business mailing address

4585 SW 185TH AVE
ALOHA OR
97078-1557
US

V. Phone/Fax

Practice location:
  • Phone: 503-713-8058
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberL11366
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: